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Healthplanfinder Business (SHOP) TAC November 12, 2015

The PACE Act, an amendment to the Affordable Care Act, changes the number of employees eligible for small group coverage from 100 to 50 starting in 2016. This article provides an overview of the changes and how they impact employers and employees.

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Healthplanfinder Business (SHOP) TAC November 12, 2015

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  1. Healthplanfinder Business (SHOP) TACNovember 12, 2015

  2. PACE Act • “Protecting Affordable Coverage for Employees Act” (PACE) • Amendment to the Affordable Care Act, passed by Congress and signed by the President this fall. • Changes the number of employees eligible for small group coverage from 100 to 50 starting in 2016. • ACA change in small group definition to 100 was slated to go in to effect 1/1/2016. • This and other ACA mandates take place for coverage starting January 2016

  3. 2016 Changes • Federal definition of eligible employees • FTEs vs. employees (bodies) • Full-time employee = 30 hours or more per week • Calculation = Actual FTEs + sum of hours of non-FTEs divided by 120 • Used to determine whether a group is a small vs a large group • Employers will need to attest to their eligibility during the application process • All FT employees must be offered coverage in order to apply for coverage in WA Healthplanfinder Business

  4. 2016 changes • Federal definition of an eligible group includes that a group must have at least one common law employee along with the employer • We will no longer be able to offer coverage to sole proprietors beginning in 2016 • Five sole proprietors are currently enrolled • HBE will inform each enrolled individual at the time of their renewal • Outside of the SHOP marketplace (state-based or federally-based), the method of counting eligible employees may differ from inside SHOP

  5. Questions ??

  6. 2016 changes • Moda Health is exiting the WA market in both individual and small group & fully-insured large group • WA Healthplanfinder Business • 30 plans to be offered instead of 47 • United Healthcare of WA will provide statewide enrollment • Kaiser Permanente – Clark & Cowlitz counties • HBE is working closely with Moda to inform all customers and brokers of the change

  7. Committee Members -- update • Kelly Allen, Kelly Allen Insurance • Insurance broker, small business owner • Lonnie Goodell, Group Health Cooperative • Director, Small Business Group & Producer Relations • Paul Hofmann, Attorney’s Title of Kitsap • Owner/President • Troy Nordlund, Pacific NW Insurance Brokerage, Inc. • Insurance broker

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